New data from FAIR Health provide valuable insights into the dynamics of in-network and out-of-network care during the first two years after the No Surprises Act took effect. Findings from this study confirm an increase in in-network participation among doctors and specialists as part of health plans’ provider networks – one of the No Surprises Act’s key goals to increase access to affordable care. These latest findings build on the recent report from AHIP and the Blue Cross Blue Shield Association which found that the law prevented 1 million surprise bills a month on average and 67% of respondents reported provider networks increased.

To better understand the impact of the No Surprises Act, FAIR Health analyzed national claims data from 2019 – 2023 (inclusive of the two years under the No Surprises Act) and focused on four specialties of interest – anesthesia, emergency medicine, pathology, and radiology – all of which were frequently associated with surprise bills preceding enactment of the No Surprises Act.

Read the full study here and see below for highlights:

  • “From the fourth quarter of 2021 to the first quarter of 2022, a relatively sharp increase in in-network percentages nationally (2.3 percent) and in all regions occurred across all specialties at the time the [No Surprises Act] (NSA) went into effect.”
  • “In-network percentages for all specialties increased 7.0 percent from the first quarter of 2019 to the third quarter of 2023. The specialties of interest increased less, by 4.7 percent, while all specialties other than specialties of interest increased by 9.3 percent.”
  • “From the first quarter of 2019 to the third quarter of 2023, radiology had the highest percentage of in-network claim lines. In-network claim lines for that specialty remained above 89 percent throughout the study period and increased by 4.0 percent.”
  • “Emergency medicine had the lowest percentage of in-network claim lines but the greatest increase overall. The percentage of in-network claim lines for emergency medicine was under 75 percent from 2019 to 2021 and under 84 percent from 2022 to 2023, but increased by 13.2 percent from the first quarter of 2019 to the third quarter of 2023.”
  • “A trend toward convergence of average in-network and average out-of-network allowed amounts was seen with emergency medicine and radiology procedure codes sampled in this report, and was also seen in FAIR Health analyses of the top 10 codes by volume in each of the following specialties: emergency medicine, pathology and radiology.”

For more information on the No Surprises Act’s safeguards, click here.